Not Covered by Insurance- Dice Hospital Review

by: Mrs. Saint

For most of my childhood, my mother worked in a hospital as a nurse manager on a rehabilitation floor. I spent more than one day at the hospital helping my mom with an event they were putting on for the residents or tagging along with my mom for Take Your Child to Work Day. When Dice Hospital went on sale on, I didn’t know anything about it or Alley Cat Games, but the hospital theme made me nostalgic so we decided to order it. 


Dice Hospital is a competitive, worker placement game with an element of dice drafting. The dice in the game are your patients. The workers you’re placing are your nurses and medical specialists. Your individual game board is your hospital ward. The game can be played with 1 to 4 people, but at the time of this review, we’ve only played it with two people.

Dice Hospital gameplay consists of eight rounds of play and each round has six phases. At the end of the eighth round, the player with the most points is declared the winner. Points are scored based on how many patients you discharge successfully each round. Points are lost if you have any fatalities. 

Each player starts with their own individual hospital board. Each board has 13 hexagon tiles, 4 of which are your patients wards, where you place your patients/dice, 8 tiles are your hospital departments where you place your workers, and the remaining tile is the Nurses Station. Each player starts out with three white nurse workers. They are placed in the Nurses Station tile in the center of your hospital. The Nurse Station is a neutral tile where your white nurse meeples are housed between rounds and does not actually do anything to help heal your patients.  

There are three colors of standard, six-sided dice: green, red, and yellow. They represent your patients and the number of pips on the die’s face represents the patient’s health status, with one being critical and near death, and six being healthy and almost ready to be released. During set up,each player draws three random dice from the dice bag. The three dice go to your ward before gameplay begins. The dice are set at: 3, 4, and 5 but you can determine which of your dice is set to which number. 

Your choice of numbers for each die may be impacted by looking at the rest of the play area. The middle of your play space will have the following: ambulances where the dice that are drawn for each round are placed, a hospital department tile and specialist cards, and the board where you keep track of your score. There will also be a pile of the new employee cards and a stack of the improvement tiles facedown. 

Play begins with the Patient Intake phase. The first player draws the appropriate amount of dice from the dice bag to fill the ambulances. The number of ambulances varies by player count, with each ambulance needing three dice. For a two player game, there are three ambulances, so you would draw nine dice. 

The first player then rolls the dice. Any dice with a 1 or 6 as its face value must be rerolled until it is neither a 1 or 6. After all dice have been rolled to an acceptable number, the first player then places them on the ambulances in ascending order. The Number 1 Ambulance gets the lowest number dice. If there is a tie between the face value of  dice, the second player chooses which dice would go on which ambulance. Once all dice have been placed, the first player then chooses their ambulance. Note: since the lowest selected ambulance dictates who becomes the first player after this phase of play, the first player is not permitted to choose the first ambulance. However, using the two player version, if the first player chooses ambulance 2 and the second player chooses ambulance three, then the first player does not change going into the next phase of play. The player with the lowest selected ambulance is now the first player and receives a blood bag, which is a single use item that can be used to upgrade a single patient’s health by one. 

Patients are then placed into the patient ward. Each of the four patient ward tiles has three patient spots which means you only have room for 12 total patients in your hospital. If you ever come to the Patient Intake phase and you do not have enough empty spaces for the new patients you just drafted, you must remove existing patients to make room for the new patients. The removals count as fatalities, so each one gives  you a token that gets placed in the Mortuary. 

The next phase is Hospital Improvement. In this phase, the first player chooses which one of the hospital upgrades they want. The specialist cards offer additional workers with different abilities. For example, the General Practitioner abilities is when you heal any one patient,  heal any one other patient of value 4,5, or 6 by one step. While if the  Urologist heals at least one yellow patient, they will also heal a different yellow patient by one step. The hospital department tiles offer additional options for placing your workers and healing up your patients. One example of a department tile is the Orthopaedics department, which allows you to heal any yellow patient three steps.

After upgrades are selected, the Hospital Activation phase is next. Using your worker meeples, you place them on your different hospital tiles to heal your patients. As patients are healed, they move down to the bottom level of the ward to indicate they’ve been treated for the round. Each worker and hospital tile may only be used once. 

Once all your meeples have been placed, you go to the Neglected Patients  phase, where any patients you did not heal this round lose a life point/go down one face value. Any meeples that are one and go down to zero are considered a fatality, causing you to receive a Fatality token and place it in your Mortuary. 

The Discharge Phase is next. When healing patients during the Hospital Activation phase, any patient healed to 7 is moved to the Discharge Lounge space on your player board. During the Discharge Phase, you count the number of patients ready for discharge and then, using your score marker, update your score on the Score/Round Tracker Board. 

The final phase of play each round is Shift Change. During Shift Change, you place all your upgraded hospital specialist meeples back on their appropriate cards. The nurse meeples return to the Nurse’s station, all patients that were in the treated portion of the ward are returned to the upper untreated area. And, if they haven’t been already, all ambulances return to the center of the play area. The first player has a few extra responsibilities. They must make sure the round marker is updated to indicate the new round and clear the unclaimed specialist/department tiles. The unclaimed tiles are returned in a random order to the bottom of their respective decks. The final step of Shift Change is the first player draws the new specialist cards and new department tiles for the new round. 

Game play ends at the end of the 8th round. Fatalities are counted and subtracted from your total score. Each Fatality is minus 2 points. If you have any Blood Bags left, you get one point for each Blood Bag. Once all points are tallied, the player with the most points wins. 

Dice Hospital does have some optional play choices. There are the Hospital Administrators, which the rulebook recommends not using the first time you play, but encourages you to use them for all future game play. The Administrators give each hospital a unique ability, some related to discharge scoring and some related to patient neglect. Another variant of play is using the Event Cards. The event cards add different effects to the game: some are immediate and some last the entire round. 

There are two other optional play variants: Hard Mode and Final Round Collection. Since at the time I am writing this review, we have not played these, I will not discuss them but you can read about them in Dice Hospital’s online rulebook if you want additional information. 


Dice Hospital does an excellent job making you feel like a frantic hospital floor manager, trying to balance your patients’ health and healing with managing the intake of new patients. Dice Hospital puts together an intricate spider web of decisions to make in order to capture the win. In order to come out ahead in final scoring, you have to begin planning right from the first decision of your starting 3 patients and setting their facing number. 

In contrast to Champions of Midgard by Grey Fox Games, another worker placement favorite of ours, where there are many avenues to winning the Glory you need to win, there is only one way to score points in Dice Hospital: discharging patients. This can be a challenge depending on the random dice drawn for that round’s Patient Intake. For example, let’s say it’s round 7 and you’ve most been drafting yellow specialists and yellow dice, but then for the previous round and the current round, there were only two yellow dice and you didn’t get a chance to draft them. This can cause you to not have the tools you need to discharge patients as quickly as you had hoped and can create a scoring disparity between you and your opponent late in the game, which could cost you the win. You need to appropriately plan and balance your dice drafting and the hospital upgrades you select to ensure you’re able to keep a steady flow of discharged patients for every round.  

For some, randomness in games is a negative thing, but for Dice Hospital, the randomness is what keeps each game fresh and exciting and from becoming a predictable formula. You never know what color dice will be drawn from the bag each round, or after they are rolled, which color dice will end up on which ambulance. You also never know what the next round will bring for department or specialist upgrades and how those options will impact your ability to heal and move patients to discharge.

For the players who live for the one-on-one feeling of competitiveness that some board games can offer, Dice Hospital is probably not the game for you. Although, yes, it’s a competitive game and you’re trying to outscore your opponent, for most of the game, you’re not really interacting with them, and even making decisions like the patient dice you draft and the hospital you upgrade are almost always made with your own player board in mind and not to “mess over” your opponent. During the Hospital Activation phase, when you’re placing your workers, you use your own board (also unlike Champions of Midgard where you’re competing for placement spaces) and do not interact at all with other players, which reminded me a lot of Roll Player by Thunderworks Games, which Mr. Saint often refers to as a multiplayer solitaire game. For Mr. Saint and I, this type of game play does not bother us, so it does not detract from our enjoyment of Dice Hospital, but I wanted to highlight it for those of you who might prefer more direct interaction in your competitive worker placement games. 

I think Dice Hospital’s playstyle and even it’s lack of one-on-one competitiveness make it a great game for board gamers of all levels of play experience. The game is easy enough to learn and teach, which makes it great for newer board gamers. The randomness and the variant play modes make it a solid game choice for more experienced board gamers looking for a bit of a challenge for game night. The base game and all components fit well into the box so transport of it is easy if you’re not the one hosting board game night that week.

Dice Hospital was a blind purchase for us, meaning we never played before buying. We rarely make blind purchases where the game hasn’t been recommended ahead of time but in this case, I’m glad we took a chance. I would recommend this as a good addition to your worker placement collection and a good gift for the upcoming holiday season if you have family and friends who enjoy board games. 

Check out more Dice Hospital reviews and information at the below links:

Board Game Atlas or BoardGameGeek– see what everyone is saying and get the latest price information.

Gaming Rules!- check out Paul’s video walkthrough of how to play Dice Hospital

Alley Cat Games – if you are interested in Dice Hospital, check out the publisher’s website to see what other great games they’ve made.

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